Valvular Insufficiency

Overview

Valvular insufficiency is a cardiac disease characterised by the failure of the cardiac valves to close perfectly, resulting in blood flowing in the opposite direction; thereby, causing regurgitation or leakage.

The disease may include one or more of the four cardiac valves:

Left side

Aortic valve insufficiency: reverse flow of blood from the aorta to the left ventricle during ventricular diastole

Mitral valve insufficiency: leaking back of blood into the left atrium from the left ventricle through the mitral valve when the left ventricle contracts

Right side

Pulmonary valve insufficiency: backflow of blood from the right atrium into the right ventricle

Tricuspid valve insufficiency: reverse flow of blood from right ventricle into the right atrium during systole

Individuals with concerns or issues with cardiac valves are either born with the disease (congenital) or acquired it later in life. In some cases, the cause of the disease is unknown.

Congenital

Congenital valve disease: more commonly affects the aortic or pulmonary valve. Congenital valve disease is characterised with incorrectly sized valves, malformation of leaflets or leaflets not attached properly to the annulus

Bicuspid aortic valve disease: affects the aortic valve. Bicuspid aortic valve disease is characterised with the presence of only two leaflets instead of three, which causes improper sealing of the valves or stiffness, resulting in leakage of blood

Acquired

Rheumatic fever: caused by streptococcus (throat bacteria) infection that is not managed. It is prevalent in children and may appear 20-40 years later if left untreated properly

Endocarditis: caused by germs or bacteria that enter the blood stream and damage the valves, leading to growths, holes in the valves and scarring

Typical symptoms of the disease include shortness of breath, dizziness or weakness, pain in your chest, palpitations, abdomen/feet/ankle swelling and unexplained weight gain.

Diagnosis and Treatment

Correction and/or management of the disease can be done through medication, or valve repair or replacement, depending on the severity of the defective valve. To properly diagnose if you have the disease, your doctor will conduct an interview to understand your symptoms and perform a physical exam by listening to the heart and the sounds it produces on closing and opening of the valves.

Depending on the result of your physical exam, your doctor may order one or more of the following diagnostic tests:

Echocardiography

Trans oesophageal echocardiography

Cardiac catheterization (also called an angiogram)

Radionuclide scans

Magnetic resonance imaging (MRI)

Your doctor may repeat the diagnostic test(s) selected over a period of time to properly evaluate your condition, and decide on the choice of treatment that you will need to undergo. Depending on the results of the diagnostic tests (which will show the severity level of the disease), you may either be treated through medication to protect your valves from further damage or lessen the symptoms, or through surgery or other procedures to repair or completely replace damaged valves. Your doctor will fully discuss your options with you.

If management is done through medication, these are the common medicines that may be given to you:

Diuretics (or "water pills")

Antiarrhythmic medications

Vasodilators

ACE inhibitors

Beta blockers

Anticoagulants ("blood thinners")

Remember to adhere to your doctor’s orders when taking medications. Know the names of your medications, what they are for, and how often to take them.

If treatment is through surgery, it may involve the repair or replacement of the valve with either the traditional heart valve surgery, a minimally invasive heart valve surgery or a less commonly used procedure such as percutaneous balloon valvotomy.

Surgeries are generally performed under general or local anaesthesia, depending on the type of procedure. It is important to follow any instructions given to you, in preparation for surgery.

These instructions generally include:

Avoid eating or drinking anything after midnight prior to surgery

Bring all your medications with you to the hospital

Arrive one hour prior to your surgery time

You may have a pre-admission appointment one to two weeks beforehand, in which you will have routine blood testing and consultation with the anaesthesiologist.

What to Expect

You will be given information about where to go and when to arrive. When you arrive, you will be taken to a pre-surgery area so that we can take your temperature, blood pressure, pulse, and listen to your heart and lungs. Depending on your particular diagnosis and surgical plan, you may have your blood tested, have an X-ray taken, or be attached to a heart monitor in the surgery room. We will place an intravenous (IV) line in your arm, so that medications may be administered before, during, and after the procedure.

Your procedure may either take a few hours or more, depending on the kind of procedure you will have.

Recovery

After surgery, you will be taken to the Post Anaesthesia Unit and monitored for any changes in blood pressure, heart rate, and breathing. An IV line will remain in your arm to keep you hydrated and administer pain medication, if necessary. You may also require the use of a ventilator to ensure air exchange and prevent pneumonia for a period after surgery.

You may require the use of oxygen when you go home, but in most cases, it is only for a few weeks. Before you go home, your nurse will teach you how to use any equipment you might need, how to care for your incision, and review your medications with you. Gradually, over the course of a few weeks, you will regain your strength and can return to work and participate in physical activity.

Be sure to call your doctor if you notice any of the following:

Bleeding

Infection

High temperature

Allergic reaction, such as redness, swelling, trouble breathing

Pain

Always take your medicine exactly as prescribed. Call your doctor if you have any questions or changes.